Day Case Transurethral Prostatectomy without Post-Operative Catheterisation: A Preliminary Study

Abstract

Background: The pain fibers from the pelvic viscera including the prostate gland, the urinary bladder, and the entire perineum are mostly carried by the sacral parasympathetic outflow via the anterior divisions of the sacral nerve roots 2, 3, and 4. Caudal anesthesia has been used over the years for out-patient procedures. It was considered that if the usual indications for postoperative admission in patients who have undergone transurethral resection of the prostate could be removed, then they too can be managed as day cases.



Method: Ten selected patients with obstructing benign prostatic enlargement on urethral catheter drainage with prostate glands weighing 60g or less on ultrasound assessment, were subjected to transurethral resection of the prostate gland (TURP) as day-cases under caudal block regional anesthesia using 2% xylocaine with 1 in 80,000 adrenaline. Hemostasis was secured until effluent of the irrigation fluid from the bladder was totally free of any visible trace of blood. A catheter was not inserted postoperatively.



Results: These patients resumed spontaneous voiding postoperatively before discharge. Their discharge on the same day did not in any way lead to any adverse events.



Conclusion: With a better understanding of the anatomy of the innervations and blood supply of the prostate gland, and proper patient selection, day-case TURP without postoperative catheterization can safely be added to the list of day case procedures. If a larger study further confirms the safety of these preliminary findings, the cost and inconvenience associated with hospitalization on the part of the patient would be reduced.

(Nig J Surg Res 2001; 3: 154 – 158)


KEY WORDS:

TURP, Day case, Catheterisation